The VA launched the MOVE! Weight Management Program for Veterans (MOVE!) across the Veterans Health Administration (VHA) in 2006. It is a multidisciplinary approach to helping overweight/obese patients manage their weight through self-management. MOVE! is set up to support patients' self-management efforts through telephone follow-up (Level 1), on-site group sessions (Level 2), and individual consultation (Level 2). By mid-2008, almost all VA facilities have implemented MOVE! at some level and more than 100,000 patients were enrolled. An early evaluation conducted by the VA National Center for Health Promotion and Disease Prevention (NCP) suggests that the program successfully helped veterans maintain or reduce their weight. At this early stage in the program implementation, the focus has been on screening and referring eligible veterans to the program. But MOVE! utilization data suggests that high attrition in MOVE! overall and in Level 2 group program may be the most serious issue MOVE! site coordinators everywhere need to address to improve the program's effectiveness. According to the NCP, only 18% of enrollees made six or more visits, a threshold the NCP considers as the minimum treatment intensity for clinically meaningful impact. Attrition in the Group Program, a Level 2 component of MOVE!, is also high. 45% dropped out after the first visit, 64% after three visits and only about 25% had 6 or more visits. An attrition rate of 75% after six visits compares poorly with attrition rates for major commercial weight management programs (19% at 13 weeks - 56% at 26 weeks). The objectives of this pilot study are (1) to identify individual, facility and provider factors that affect attrition rates in the MOVE! Group Program through a secondary data analysis and (2) to identify best practices in the VAs with the highest retention rates in the MOVE! in general and the Group Program in particular. We will use administrative databases to identify MOVE! Group Program enrollees in 2008. We will use various sources of VHA data (including Outpatient, Enrollment, and NCP Annual Report) to identify factors that affect their attendance in the Group Program during one year after enrollment. Multivariable analyses will be used to identify factors that are associated with improved retention rates in MOVE! overall and the Group Program in particular.

Public Health Relevance

MOVE! is a VA-wide weight management program for helping overweight or obese veterans. To improve the effectiveness of this program, it needs to address the problem of high attrition overall and in the Group Program specifically. This pilot study will help identify program features and provider characteristics that are associated with high attrition rates that can be used to implement more effective MOVE! Group Program across the VA. We will use the results of this pilot study to develop a larger proposal for an implementation research in which a model of MOVE! Group Program suited best for a site given its physical limitations, facility characteristics, and patient mix is identified and implemented at sites with poor retention rates. This research will help improve the effectiveness of MOVE!